I will be attending as staff:(Required) Yes No Name(Required) First Last Date of Birth(Required)MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age(Required)Please enter a number from 0 to 120.Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Gender(Required) Male Female Phone(Required)Email(Required) Enter Email Confirm Email T-Shirts - $20(Required) Small Medium Large X-Large 2X-Large 3X-Large 4X-Large No T-Shirt T-Shirts have to be pay for in advance. Local Church(Required) Consent(Required) I agree to the condition below.Rules for acceptance & participation of camp are the same for each person without regard to race, gender or national origin. Please do not bring electronics. Camp will not be responsible for lost or damaged electronics. There will be no pillow fighting, water guns or water balloons used inside a building. No shaving cream fighting or playing, illegal drugs, tobacco products, alcohol, fireworks of any kind or weapons of any kind. I understand that when signing this application, I am agreeing to abide by all rules and regulations of the camp. If I break any rule, I understand that I am subject to disciplinary correction even to the expelling from camp. The Church of God Family Camp Dress Code: To Parents and Campers. This is a Christian Camp. Please dress accordingly. Boys should wear long pants, girls' hemline BELOW the knee (hemlines need to be below the knee while sitting). The following clothes ARE NOT ACCEPTABLE: shorts, leggings, tank tops, sheer fabrics, sleeveless tops, no cut-offs, no bare stomach or back showing, no low-cut tops, no shirts with profane words and/or pictures. To all church services - girls should wear dresses or skirts, boys should wear jeans or slacks. If girls choose to wear leggings under their dresses/skirts, the hemline still must be below the knee. PLEASE MARK ALL PERSONAL ITEMS WITH CAMPER'S NAME. Camping staff WILL NOT BE RESPONSIBLE for missing clothing or items left on campground.Spiritual InformationSaved?(Required) Yes No Sanctified?(Required) Yes No Holy Ghost?(Required) Yes No Member of The Church of God?(Required) Yes No Do you hold any positions as a church leader?(Required) Yes No If yes, please list positions currently held.Do you believe and practice the church teachings and advice as set forth by the General Assembly?(Required) Yes No Are you willing to assume any responsibilities you may be placed in?(Required) Yes No Will you abide by the rules of camp & encourage others to do the same?(Required) Yes No Are you willing to forget about yourself & put the needs of campers first?(Required) Yes No Can you be at camp on time & stay until released from duties?(Required) Yes No Do you participate in your local church's activities consistently?(Required) Yes No Will you attend camp meetings, if possible, for instruction & duties?(Required) Yes No I am able to attend International Youth Camp (IYC) if selected to be sponsored.(Required) Yes No IYC is August 30-Sept 2, 2024Pastoral Endorsement(Required) I agree to the condition below.I will obtain a staff endorsement from my pastor (or state overseer if I am a pastor) by having them complete the form located on the website. Signature(Required)Date(Required) MM slash DD slash YYYY Have you ever been charged or convicted of a crime involving a minor or a crime that involved any sexual conduct?(Required) Yes No The Following Must Be Answered & Signed To Be Able To Work In Camp (this is a requirement of the Insurance Company and is no reflection of The Church of God. All information received is confidential and is held at the State Office.) -The Authorization for Criminal Background Check MUST be completed if you have not previously filled one out. Contact Sis. Debbie for details.Health InformationName(Required) First Last Health Conditions(Required) Rheumatic Fever Seizures Fainting Asthma/Respiratory Tuberculosis Diabetes Kidney Problems Heart Trouble Sleep Walking Poison Ivy, Oak, Sumac Recent Surgery None Please check all that apply.Allergic Reactions(Required) Bee Stings Drugs Food(s) None Please give a more detail of what you are allergic to and your allergic reactions in the box below.Additional Health concerns, allergies and/or limitationsIf you checked any of the boxes other than NONE for the previous two questions please give details here. You may also add any additional details of concerns in this box.Please list any prescribed medications you are taking All medications is to be given to the camp nurse to administer to the camper unless approved by camp administration.Insurance InformationName(Required) First Last Insurance Provider(Required) Group Number(Required) Policy Number(Required) Emergency Contact(Required) First Last Relationship(Required) Emergency Phone Number(Required)Payment InformationTuition Amount(Required) 1 Person - $80.00 2 People - $150.00 3 People - $220.00 4 People - $290.00 5 People - $360.00 6 People - $430.00 FAMILY PLAN (Cost reflects ages 6 and up) (family must live in same household) Choose the plan of the number in the household that is age 6 & up. For ages of 3-5, you will add $20 to family plan to cover food cost. Ages 2 & under - no cost. The SNACK SHACK will be open to purchase snacks/drinks. This is NOT included in the tuition. Snack Shack cards can be purchased in advance or at camp. ($5 per card) *Deduct $5 from plan for each member of staff. APPLICATION DEADLINE May 1, 2023 No applications after deadline unless extenuating circumstances occur.Name for other members in your family plan.